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The following is a summary of “Preoperative Immersive Virtual Reality Applied to Percutaneous Nephrolithotomy: A Prospective Randomized Clinical Study of Surgical Planning and Clinical Outcomes,” published in the February 2025 issue of Journal of Urology by Cumpanas et al. 

Percutaneous nephrolithotomy (PCNL) is used to manage complex or large renal stones. Surgeons face challenges in converting over 2000 static CT scan images into a functional mental image for effective surgical planning. 

Researchers conducted a retrospective study to explore the potential of immersive virtual reality (iVR) in enhancing surgical planning for PCNL.  

They randomized 175 patients undergoing PCNL between 2019 and 2023 into a CT-only group (N = 89) and a CT+iVR group (N = 86). CT scans were rendered into iVR models, allowing surgeons to visualize, manipulate anatomy, and simulate the percutaneous approach. Postoperative CT scans were classified as absolute stone-free, < 2 mm remnants, or 2.1 to 4 mm remnants. 

The results showed preoperative iVR visualization changed the calyx of entry in 30% of cases. The CT+iVR group had a significant improvement in absolute stone-free rate (33.70% vs 20.22%, P = .043) and < 4 mm remnant rate (62.79% vs 48.20%, P = .044). Clavien-Dindo II+IIIa complications were lower in the iVR group (3.48% vs 12.30%, P = .03). Results were independent of surgeon experience. 

Investigators found that preoperative iVR model visualization benefited both surgeons and patients. The iVR model resulted in a safer, more effective percutaneous stone removal procedure. 

Source: auajournals.org/doi/10.1097/JU.0000000000004284